16.4 Urinary Incontinence
Open Resources for Nursing (Open RN)
Urinary incontinence is the involuntary loss of urine. Although abnormal, it is a common symptom that can seriously affect the physical, psychological, and social well-being of affected individuals of all ages. It has been estimated that 1 in 5 women develop urinary incontinence, but many are too embarrassed to discuss the condition with their health care providers. Some believe it’s a normal part of aging that they have to live with. The result can be isolation and depression when they limit their activities and social interactions because of embarrassment due to incontinence. Nurses can greatly improve the quality of life for these clients by assessing for incontinence in a sensitive manner and then providing health teaching about methods to prevent and/or manage incontinence.
Types of Urinary Incontinence
Continence is achieved through an interplay of the physiology of the bladder, urethra, sphincter, pelvic floor, and the nervous system coordinating these organs.[1] A disruption in any of these areas can cause several types of urinary incontinence[2],[3]:
- Stress urinary incontinence is the involuntary loss of urine with intra-abdominal pressure (e.g., laughing and coughing) or physical exertion (e.g., jumping). It is caused by weak pelvic floor muscles that is often the result of pregnancy and vaginal delivery, menopause, and vaginal hysterectomy.
- Urge urinary incontinence (also referred to as “overactive bladder”) is urine leakage caused by the sensation of a strong desire to void (urgency). It can be caused by increased sensitivity to stimulation by the detrusor muscle in the bladder or decreased inhibitory control of the central nervous system.
- Mixed urinary incontinence is a mix of urinary frequency, urgency, and stress incontinence.
- Overflow incontinence occurs when small amounts of urine leak from a bladder that is always full. This condition tends to occur in males with enlarged prostates that prevent the complete emptying of the bladder.
- Functional incontinence occurs in older adults who have normal bladder control but have a problem getting to the toilet because of arthritis or other disorders that make it hard to move quickly or manipulate zippers or buttons. Clients with dementia also have increased risk for functional incontinence.
It is important for nurses to understand the different types of incontinence so that appropriate interventions can be targeted to the cause.
Assessment of Incontinence
Assessment begins with screening questions during a health history, including questions such as, “Do you have any problems with the leakage or dribbling of urine? Do you ever have problems making it to the bathroom in time?” If a client responds “Yes” to either of these questions, it is helpful to encourage them to start a voiding diary to record their urination habits and activities. The voiding diary should include the following[4]:
- When and how much the client u